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ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY ' Waste Tire Survey and Inspection Report 304 E WEBER AVE 3' FL - STOCKTON CA 95202-2708 State of California (209) 468-3420 CIWMB-54(10/03) PART A — General Information/Survey Page 4 of INSPECTION ISITE VISIT Type(Check one) Routine ❑ Re-inspection ❑ Complaint ❑ Observation ❑ CM/MB Referral ❑CHP Referral ❑ Other Facility SWIS: Inspected by: Time In: ; Date' Regulatory Stat File No. TPID: ❑County/City 5' L ❑Permitted Excluded El Exempt❑ Unpermitted I S 7`t�--� ' Code: Hauler ID: El State Time Out: Total Time: Opefationat Status: Local: I�ctive❑Closed❑Inactive Cl Planned Business/Facility Name: Tire Count: Type/ 1 Inc) assenger[]Altered[]Truck[IOTR Address: ) Phone: St age Type: �_ a'xrYO cl f— '5- L_ bq--016 Outdoor❑Indoor❑Container Owner: Inspect t(Please Print).* Business Rep: �G�1 . �:�fi�i✓� �;r c. Title: Facility Type:(Check one) Role of Business:(Check all that apply) ❑ Major WTF(>5.0c0 t.res) ❑ Minor WTF(>500 tires) ❑Waste Tire Location <500 tires) Generator ❑Hauler ❑ End-use Busi ss Type:(Check all that apply) Eg"Tire Dealer ❑ Retreader ❑ Dismantler ❑Auto Reca r ❑Auto Body ❑Car Dealer ❑Collection ❑ Gas Station ❑Trucking Fleet ❑ Shredder ❑Crumb R--ter ❑ Other: Describe Excluded Business Types(check only if Applicable): ❑ 14 CCR§ 18420(a)(3)-Facilities storing less than 500 waste tires(V)as:e Tire Location). ❑ 14 CCR§ 18420 (a) (4)-Tire retreading facility with no more than 3.0'.3,vas:e tires on premises. ❑ 14 CCR § 18420(a) (6)-Auto dismantler storing no more than 1,500 .ras:e tires for less than 90 days. 14 CCR§ 18420 (a) (7)& (e)-Tire dealer storing no more than 1,500 ..as:e tires for less than 90 days. If exclude?`-om permit.complete Parts B and D If not excluded from permit requirements complete Pars° a-�D. PART B — Inspection of Waste Tire Dealer, Generator, Hauler and End-Use Facility V A C HAULING AND MANIFESTING REQUIREMENTS ❑ ❑ ❑ PRC§42951 (a)-Waste Tire Hauler Registration and Transco-of Tres. ❑ ❑ ❑ PRC§42953-Contracts with Registered Waste Tire Haulers ❑ ❑ ❑ 14 CCR§ 18459.1 (a)(b)(c)-Tire Program ID Number from CP,'/MB ❑ ❑ ❑ 14 CCR§ 18459.2.1 -Submittal of Manifest Forms and Tire Tr o Logs within 90 days. ❑ ❑ ❑ 14 CCR § 18459.3 -Retention of Manifest Forms and Tire Tr- Logs for 3 years ❑ ❑ ❑ 14 CCR§ 18460.2 -Manifest System Requirements for Regs:e-ed Waste Tire Haulers. ❑ ❑ ❑ 14 CCR§ 18461 -Manifest System Requirements for Waste T-e End-Use Facilities. ❑ ❑ ❑ 14 CCR § 18462-Manifest System Requirements for Tire De=_e,s or Waste Tire Generators. PART C — Inspection of Waste Tire Facility V A C WASTE TIRE STORAGE STANDARDS V A C WASTE TIRE STORAGE STANDARDS Permits Requirements [ [ [ 14 CCR§17352-Site Security ❑ ❑ ❑ PRC§42824—Major Waste Tire Facility Permit ❑ (a)Signs ❑(b)Site Attendant ❑ (c)Access ❑ ❑ ❑ PRC§42834—Minor Waste Tire Facility Permit ❑ ❑ ❑ PRC§42850(a)—Complies with Terms of Permit [ I [ [ 14 CCR§17353(a)-Vector Control ❑ ❑ ❑ 14 CCR§ 18420(a) —Applicable for Permit ❑ (1)Impermeable Barrier ❑ (2) Approved Vector Plan ❑ ❑ ❑ 14 CCR§ 18423 —Filing Application for Permit [ FET FE 14 CCR§17354-Storage of Waste Tires Outdoors Recordkeeping Requirements ❑ (a)Storage Units ❑ ❑ ❑ 14 CCR § 18432—Operations Plan ❑ (b)Fire Lanes ❑ (c)Fire District Requirements ❑ ❑ ❑ 14 CCR§ 18433—Emergency Response Plan ❑ (d)Drainage ❑ ❑ ❑ 14 CCR§ 18447—Records Available ❑ (e)Slope/Grade ❑ (f)Siting(New Facilities) [ ❑ 1 [ 14 CCR§17351 -Fire Prevention Measures ❑ (g)Rim Removal ❑ (a) Communication Equipment ❑ (h) Protection from Pyrolytic Oil Runoff ❑ (b) Fire Equipment [ [ [ 14 CCR§17356 -Indoor Storage ❑ (c)Water Supply E] (d) Other Requirements Facility compliance with NFPA 231D-1989